greenstick fracture

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Greenstick fracture on X-ray.

A greenstick fracture is a fracture in a young, soft bone in which the bone bends and partially breaks. A person's bones become harder (calcified) and more brittle with age. Greenstick fractures occur almost exclusively during infancy and childhood when one's bones are soft. The name is by analogy with green wood which similarly breaks on the outside when bent.

There are three basic forms of greenstick fracture. In the first a transverse fracture occurs in the cortex, extends into the midportion of the bone and becomes oriented along the longitudinal axis of the bone without disrupting the opposite cortex. The second form is a torus or buckling fracture, caused by impaction. The third is a bow fracture in which the bone becomes curved along its longitudinal axis.

Pathogenesis and risk factors

The greenstick fracture pattern occurs as a result of bending forces. Activities with a high risk of falling are risk factors. Non-accidental injury more commonly causes spiral (twisting) fractures but a blow on the forearm or shin could cause a green stick fracture. The fracture usually occurs in children and teens because their bones are flexible, unlike adults whose brittle bones usually break. It is also common in older adults.

Greenstick fractures should not be confused with buckle fractures (or torus fractures) which are an impaction type of fracture identified by a focal widening (or outward buckling) of the cortex.

Clinical features

Some clinical features of a greenstick fracture are similar to those of a standard long bone fracture- greenstick fractures normally cause pain at the injured area. As these fractures are specifically a paediatric problem, an older child will be protective of the fractured part and babies may cry inconsolably. As per a standard fracture, the area may be swollen and either red or bruised. Greenstick fractures are stable fractures as a part of the bone remains intact and unbroken so this type of fracture normally causes a bend to the injured part, rather than a distinct deformity.

Treatment

The standard treatment is closed reduction and cast application which work in concert to straighten the characteristic bone angulation at the fracture site. Fracture reduction is straightforward; pressure is applied to the apex of the deformity and the bone straightens. Although rarely necessary, postoperative traction may be utilized to straighten a particularly resistant fracture. Typical post-operation treatment is simply the application of a cast to stabilize the affected limb. Once applied, a cast is usually in place for three or more weeks depending on the severity of the fracture and rate at which the bone heals. During this period the patient should be encouraged to elevate the cast extremity above the level of the heart to reduce swelling and to exercise the joints above and below the cast in an effort to maintain and promote flexibility and muscle strength. Once the cast is removed a period of activity restriction in conjunction with informal physical therapy is typically necessary to regain pre-injury strength and mobility. It is not usually necessary to have formal physiotherapy.

See also

• Salter-Harris fractures